KODY C LEWIS Physician Assistant License verification

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****87

License Status

NOT RENEWED

Business

First Name

KODY

Middle

Last Name

LEWIS

Business Name

KODY C LEWIS

Original Issue Date

06/23/2009

Effective Date

01/10/2022

Expiration Date

03/01/2024

City

ELK GROVE VILLAGE

State

Zip

60007

County

COOK

Delegated Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

02/05/2025